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J Emerg Med. 2017 Mar;52(3):370-376. doi: 10.1016/j.jemermed.2016.11.017. Epub 2016 Dec 14.

Impact of Scribes on Billed Relative Value Units in an Academic Emergency Department.

Author information

1
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
2
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
3
Mayo Clinic Revenue Cycle, Mayo Clinic, Rochester, Minnesota.

Abstract

BACKGROUND:

Scribe use throughout health care is becoming more common. There is limited peer-reviewed literature supporting this emerging role in health care despite rapid uptake of the role.

OBJECTIVES:

Our study assesses impact of scribes on relative value units (RVUs) in adult and pediatric emergency departments (EDs).

METHODS:

A prospective cohort study was developed in a tertiary academic ED. Charts were coded by an external billing and coding company, then returned and mapped by International Classification of Diseases, 9th revision diagnostic codes. After training by a staff member with significant experience in implementing scribe programs, scribes provided 1-to-1 support to a provider as staffing allowed. Comparisons were made between scribed and nonscribed visits.

RESULTS:

There were 49,389 patient visits during the study period (39,926 adult [80.84%] and 9463 pediatric [19.16%] visits), of which 7865 (15.9%) were scribed. For adults, scribed visits produced 0.20 additional RVUs per patient (p < 0.001). Scribes generated additional RVUs in Emergency Severity Index (ESI) 2 (p < 0.001) and 3 (p < 0.001) patients. There were variable effects of scribes on RVUs by diagnostic codes. For pediatric patients, scribed encounters generated 0.08 fewer RVUs per patient (p = 0.007). ESI score had no effect on RVUs. The impact of scribes on pediatric diagnostic groupings was inconsistent.

CONCLUSIONS:

Scribes had a positive impact on RVUs in adult but not pediatric patients. Among adults, scribes led to higher RVUs in ESI 2 and 3 but not 4 and 5 patients, perhaps suggesting a limitation to improve revenue capture on lower-acuity patients.

KEYWORDS:

RVUs; documentation; emergency department; relative value units; revenue; scribe

PMID:
27988262
DOI:
10.1016/j.jemermed.2016.11.017
[Indexed for MEDLINE]

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